Winter 2007 Newsletter
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John D. Butts MD, Chief Medical Examiner Lynn Poole, Layout Editor |
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W I N T E R 2 0 0 7 |
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Table of Contents
- New Facilities
- Tox Collection Kits
- Annual Seminar
- OCME Website
- Evidence Collections
- Timely Completion of Death Certificates
- New Medical Examiner Cards
NEW FACILITIES
Planning is now actively underway and into the design phase for a new combined State Public Health Laboratory and Office of Chief Medical Examiner facility to be located in Raleigh. The current time table projects a completion date sometime in 2010. The OCME long ago outgrew its current facilities and we are excited at the prospect of more spacious quarters. This will allow expansion of our toxicology laboratory and help us better respond to the staggering increase in the number of overdose deaths that we have been experiencing in recent years. The new facilities will also be specifically planned and equipped to better handle any mass fatality incidents that might occur in our state.
TOX COLLECTION KITS
We hope that all of you have been receiving the new tox collection kits and are utilizing them. Please do not use any old ones that you may have left over unless you are desperate. You will note again that the non-autopsy kits have provision for two specimens. We would urge you once more to try to get two separate samples from your cases particularly any case where there is a likelihood that alcohol may be present and relevant to the understanding what happened to that individual. A good sample of peripheral blood and an alternative sample of urine, vitreous or another blood site gives us two toxicological points of reference. If there is only a single sample and the result is positive for alcohol it may be challenged as being contaminated or unrepresentative. Having two results allows us to rebut this charge.
Also be sure to fasten the vials securely and place them in the foam sleeve and then in the zip lock plastic bag. Be sure to seal the bag before placing in the secondary container. We recommend freezing the kits for twenty-four (24) hours before mailing; also avoid mailing late in the week if possible, so that the samples do not linger unduly in the post office.
ANNUAL SEMINAR
Last year's medical legal seminar was well attended with over 110 participants. The 2007 seminar is scheduled for Saturday, June 2nd. This year's agenda will focus on the current state-of-the-art modern crime lab, the investigation of traffic wrecks and collisions, the legal definition of homicide, exhumations, and a few other topics. We will be getting a brochure out to you within a month or two and urge you to mark off June 2nd on your calendar for a visit to Chapel Hill for our 2007 Medicolegal Seminar. Everyone is invited to register for this one day seminar.
OCME WEBSITE
Most of you, we hope, are aware of the fact that there is a great deal of information about the ME system on our website www.ocme.dhhs.nc.gov. This includes our statutes, rules and regulations as well as the guidelines for medical examiners. The statutes provide the legal basis for our system and the guidelines a rough framework of what our responsibilities as medical examiners entail. Through the website, requests for reports may be submitted and the body transporters for individual counties are listed. There is also historical and statistical information for those with an interest in the system or the deaths that we investigate.
EVIDENCE COLLECTIONS
This is most relevant to pathologists performing medicolegal autopsies in North Carolina, but may also be of interest to all MEs.
Fingernail scrapings are often requested by law enforcement agencies from homicide victims. Their rationale is that in a struggle the victim may scratch or claw the perpetrator and some tissue (and thus DNA) may be caught under the fingernails. If that material can be recovered it may reveal the identity of their attacker. The NC SBI crime laboratory, however, will not accept either fingernail scrapings or clippings for examination because of the typical absence of any positive results. If you are asked to collect such evidence you should instead visually inspect the nails and carefully collect only visible foreign tissue material that you observe. Remove same with a clean sharp tweezers and place it into a clean envelope, marked as tissue or foreignmaterial removed from (decedent's name) . Stray hairs and fibers can also be collected. Swabs of blood found on the hands of victims who have no wounds of their own may be of value since they may also have come from the perpetrator. They should be air-dried and placed in a clean paper envelope.
Victim exemplars are just as critical and must be properly collected. Blood is the most important. Saving liquid samples is inappropriate. Rather blood should be deposited in drops on a piece of clean filter paper (a pediatric blood card can be used), dried and then sealed in a clean paper envelope, not plastic.
TIMELY COMPLETION OF DEATH CERTIFICATES
One of our most important responsibilities as medical examiners is to complete a medical examiner certificate of death in each case that we accept for investigation. Please remember that if you accept a case, obtain a tox sample and fill out a Medical Examiner Report of Investigation you must also complete a medical examiner death certificate. If you take a call on a case and decide that it is in fact not an ME case and allow the attending physician to certify the death please do not send us a report of investigation as that will automatically generate a request to you for a medical examiner death certificate. If you wish to make a note for your own file that you reviewed the case please do so, but do not send it to us. Conversely, if you fill out an ME Death Certificate it must at some point be followed with a ME Report of Investigation.
The law requires that the medical certification of death, which would include ME certifications, be done within three days of the death (or notification of same) and the funeral director or person acting as such is supposed to file the death certificate with the health department within five days of the death or notification of same. Some of you generate the certificates yourself and release them with the body while in other counties, it may be the practice to have the funeral director prepare a certificate and bring or mail it to your office. Regardless, please do not sit on these certificates. You should not wait for the results of toxicology or further autopsy studies if they are not going to be available within a day or so. It is much better to sign the certificate asPending and release it. While a death certificate that says Pending may be problematic for some insurance purposes, it nonetheless constitutes proof of death and is sufficient for most estate purposes.
NEW MEDICAL EXAMINER CARDS
Since the inception of the system in the 60's and early 70's the Badge of Office mailed out to each medical examiner was a blue appointment card. These were typed out individually by our staff and then signed by the Chief Medical Examiner. As with most procedures, automation has caught up with this one and we have finally been able to generate them electronically, eliminating the typing step. For the moment, the new cards are white, as well as electronically signed. They are, however, still laminated and confirm your authority as a North Carolina County Medical Examiner.